Provider Demographics
NPI:1124080130
Name:HEAVRIN, BARRY G (DDS)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:G
Last Name:HEAVRIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-2724
Mailing Address - Country:US
Mailing Address - Phone:620-421-1479
Mailing Address - Fax:
Practice Address - Street 1:2326 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-2724
Practice Address - Country:US
Practice Address - Phone:620-421-1479
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS58871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS7875OtherBCBS OF KS PROVIDER ID